PARANASAL SINUSES

Dr. Swati Gupta Associate professor Department of Oral Medicine and Radiology

PARANASAL SINUSES

THE OSTEOMEATAL COMPLEX • Region where the frontal ,anterior and middle ethmoid and maxillary sinuses

drain .

• Includes the fronto ethmoidal recess , uncinate process , hiatus semilunaris ,

ethmoid bulla , the maxillary infundibulum and ostium and the ethmoid

infundibulum .

• Disease at the OMC is the major cause of recurrent acute/chronic sinusitis .

DISORDERS OF MAXILLARY SINUS

• TRAUMATIC-Fracture, OAF, Foreign body, haematoma, contusion

• INFECTIOUS/INFLAMMATORY – Non-specific-Mucositis, sinusitis, Antral polyps, Empyema, Periostitis – Specific- fungal(actinomycosis,mucormycosis), bacterial(Tuberculosis, Wegner’s

granulomatosis)

• CYSTS – Intrinsic-retention pseudocyst, Mucocoele – Extrinsic-odontogenic (radicular, Dentigerous and keratocyst) and non odontogenic

(Globulomaxillary, Traumatic, aneurysmal)

• NEOPLASMS • Benign

– Intrinsic-Epithelial papilloma, Osteoma – Extrinsic-Ameloblastoma, adenoameloblastoma, odontome, CEOT

• Malignant – Intrinsic-SCC, Adenocarcinoma, Ca of salivary gland origin, Sarcoma, melanoma, Lymphoma

– Extrinsic- SCC, metastatic, Ca of salivary gland origin, Sarcoma, melanoma, Lymphoma

• METABOLIC AND ENDOCRINAL- Hyperparathyroidism, fibrous Dysplasia, Paget’s Disease

• CALCIFICATIONS-ANTROLITH • SYNDROMES- Crouzon’s, Treacher Collins, Binder’s

SINUSITIS

• ACUTE

• SUBACUTE

• CHRONIC

DIAGNOSIS:

Xray: WATER’S

VIEW.

CT is

preferred..

ANTERIOR NASAL

ENDOSCOPY

TRANSILLUMINATION OF MAXILLARY SINUS

TRANSILLUMINATION TEST:

TRANSILLUMINOSCOPE

MANAGEMENT OF SINUSITIS

• Antimicrobial drugs

(ampicillin/amoxicillin/erythromycin)

• Nasal decongestant drops ( 0.1% oxy or xylometazoline).

• Steam inhalation.

• Analgesics.

• Hot fomentation.

• SURGICAL- Antral lavage

PANSINUSITIS

It is the sinus infection lasting for months or years.

Important cause is failure of acute

infection to resolve.

PATHOPYSIOLOGY:

Pollution,chemicals,infec

tions.

LOSS OF CILIA

IMPAIRED

DRAINAGE

Polypi,

DNS,

adenoid

s,

tumors,

allergy

INFECTION

Inadequate therapy of acute sinusitis

MUCOSAL

CHANGES ALLE

RGY

DIAGNOSIS:

Xray (mucosal

thickening)

Xray with contrast.

CT

Aspiration( pus is

confirmatory).

TREATMENT

Cause for obstruction of sinus drainage and

ventilation to be found out.

Work up on nasal allergy may be required..

Culture and sensitivity ( selection of antibiotic).

Conservative management(antibiotics,

decongestants, antihistaminics)

SURGICAL MANAGEMENT

• Antral puncture and irrigation.

• Intranasal antrostomy.

• Caldwell-luc operation.

Nasal antrostomy

MUCOSITIS

Periostitis

Mucous Retention Pseudocyst

POLYPS

A left sided ethmoidal mucocele (A)

encroaching on the left orbit.

Left globe in proptosed.

T2W MR axial and coronal sections (B)

of the same patient showing

hyperintense fluid contents of the

mucocele

MUCOCELE

OSTEOMA

ANTROLITH

ROOT PIECE IN

SINUS

SCC OF MAXILLARY SINUS

ANATOMICAL VARIANTS

THANK YOU